Case Manager I (Prior-Authorization Nurse)
Centene Corporation - Manchester, NH

This job posting is no longer available on Centene Corporation. Find similar jobs: Case Manager jobs - Centene Corporation jobs

This position will be with Granite State Health Plan, a subsidiary of Centene Corporation.

Position Purpose:
Review requests for prior authorization of medical services such as surgeries, pain management, home health care.

Knowledge/Experience:
At least two years clinical nursing experience. Experience utilizing medical management software programs.

Position Responsibilities:
  • Review provider requests through fax or telephone to ensure medical necessity for services requiring preauthorization.
  • Utilize nationally recognized criteria to determine medical necessity of services requested.
  • Refer provider requests appropriately to Medical Director when medical necessity of services is not met based on the criteria.
  • Act as a clinical resource to referral staff
  • Act as a liaison between the Provider and the Medical Director
  • Data enters authorizations into the system.
Licenses/Certifications: RN, LPN or LVN required. Current state nursing license.

Centene Corporation - 20 months ago - save job - block
Recommended Jobs
Nurse - Case Manager
Medix Staffing Solutions Inc. - Bedford, NH
Medix Staffing Solutions Inc. - 30 days ago

Medical Director New Hampshire
BMC HealthNet Plan and Well Sense - Manchester, NH
Boston Medical Center HealthNet Plan - 30+ days ago
About this company
137 reviews
Centene is sensitive to the needs of individuals and families enrolled in government-assisted health programs. The company provides managed...